Lichenoid chronic graft-versus-host disease-like acrodermatitis induced by hydroxyurea

Clinical, Histopathological Characteristics and Immunohistochemical Findings in Lichen Planus Pigmentosus

Background:

Lichen planus pigmentosus (LPP), a rare variant of lichen planus, is reported in various ethnic groups, more often from the Indian subcontinent and the Middle East.

Aims:

Although the condition is encountered quite often by dermatologists of this region, the data on the clinical, pathological, and immunohistochemical (IHC) aspects of LPP are limited. This prospective study is aimed towards filling this lacuna.

Materials and Methods:

Data were collected from thirty clinically diagnosed cases of LPP who presented to the dermatology outpatient department. Skin biopsy and blood investigations were conducted and the specimens were further analyzed for their histopathological features and IHC staining for CD4⁺, CD8⁺ T-lymphocyte subsets along with CD45RO (UCHL-1), and CD68. The results were statistically analyzed.

Results:

The study showed a female preponderance (56.7%). Photo aggravation as a precipitating cause was seen in 40% of the individuals. The lesions with duration <4 months had a more intense inflammatory infiltrate on histology. CD4⁺ and CD8⁺ cells showed very good Pearsons correlation on statistical analysis. CD45 was seen in association with CD8⁺, and staining for CD68 to assess the macrophage density showed a close correlation with CD45RO.

Limitations:

Small sample size.

Conclusion:

LPP represents a misguided lesional immune response pattern. The intense inflammatory infiltrate seen in the early lesions necessitates prompt treatment to arrest progression which may prevent the chronic pigmentary phase of the disease.

Secondary cutaneous effects of hydroxyurea: possible pathogenetic mechanisms

We report the case of a 73-year-old man who had been on hydroxyurea for essential thrombocythemia since 1988. After 12 years of treatment he developed a symmetrical dermatomyositis-like eruption together with a leg ulceration and five squamous cell carcinomas of the face. The possible pathogenetic mechanisms of these known side effects are discussed.

Cutaneous adverse reactions to hydroxyurea in patients with intermediate thalassemia

Although the cutaneous effects of hydroxyurea have been described for patients with sickle cell anemia, myeloproliferative disorders, and psoriasis, there are no reports of cutaneous adverse effects from hydroxyurea when used for patients with intermediate thalassemia. Therefore 43 patients with intermediate thalassemia treated with hydroxyurea were examined by a dermatologist, and pertinent cutaneous findings were recorded. These patients had received hydroxyurea for a mean of 15.5 months. Nineteen had cutaneous hyperpigmentation, eight had xerosis, and three were found to have one cafe au lait macule each. Eleven patients had nail abnormalities, including nail ridging, partial leukonychia, and longitudinal melanonychia. There were no cases of leg ulceration. It was concluded that the risk of developing leg ulcers and pigmentary disorders appears to be related to the underlying disease being treated, as well as to a patient's age, gender, and pigmentation.

Onychomycosis caused by an isolate conforming to the description ofTrichophyton raubitschekii

Trichophyton raubitschekii is currently regarded as a synonymous name betokening a variant form of Trichophyton rubrum. Nonetheless, isolates conforming to this morphotaxonomic concept have morphological, physiological and clinical features very different from those of typical T. rubrum. Isolates are mainly obtained from subjects originating from certain tropical and subtropical countries, and are mainly obtained from upper body skin infections, rarely from onychomycosis. In this paper the authors report the first known Italian case of onychomycosis caused by such an isolate. The patient, a male student from Cameroon, had a typical fingernail tinea unguium, without any other sign of skin or nail infection. 'T. raubitschekii' was identified on morphological and physiological grounds by the following features: velvety colony surface, brownish pigment, abundant macroconidia and microconidia, and positive urease activity. Such isolates may prove very difficult to identify correctly, especially in areas like Italy where T. rubrum is normally seen only as isolates presenting a strongly differing phenotype.